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NPI Code Detail

MEDICARE: MR. MICHAEL WAYNE MCNULTY LPC

MEDICARE:  MR. MICHAEL WAYNE MCNULTY  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLPC000664GA
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1013934090
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL WAYNE MCNULTY LPC
Provider Business Mailing Address
First Line : 2330 SCENIC HWY S STE 204
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-3115
Country : US
Telephone Number : 770-289-8217
Fax Number : 888-502-0589
Provider Business Practice Location Address
First Line : 2330 SCENIC HWY S STE 204
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-3115
Country : US
Telephone Number : 770-289-8217
Fax Number : 888-502-0589
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2006
Last Update Date : 10/04/2017

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